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市場調查報告書

美國政府的醫藥品償付:成功的重要處方藥定位及價格管理

US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems

出版商 Cutting Edge Information 商品編碼 320273
出版日期 內容資訊 英文 55 Pages
商品交期: 最快1-2個工作天內
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美國政府的醫藥品償付:成功的重要處方藥定位及價格管理 US Government Drug Reimbursement: Winning Key Formulary Positions and Managing Pricing Systems
出版日期: 2014年11月30日 內容資訊: 英文 55 Pages
簡介

本報告提供生命科學企業的美國政府醫療費償付相關業務的管理方法相關分析,闡明產品生命週期整體的最佳業務實踐的,製藥企業的主管和顧問的討論彙整,為您概述為以下內容。

摘要整理

  • 調查定義
  • 美國政府保險者的管理:成功的3個建議

經由美國政府保險者獲得最適合的處方藥定位

  • 決策者保持掌握資訊,與政府保險者訂立持續契約
  • 預測政府保險者的期待

為了更善加導航美國政府的醫療費償付而實行明白的價格流程

  • 為了促進一貫性政府醫療費償付策略,採用複數的功能
  • 使用特定的標準建立醫療費償付次序

結構、預算分配及外包使政府的醫療費償付能力擴大

  • 為了改善內部協調通訊,設置醫療費償付團隊
  • 政府的醫療費償付預算分配的基準、指南
  • 為了構築醫療費償付模式、確保遵守,而採用供應商
目錄
Product Code: PH204

Life science companies navigating US government payers' complex guidelines for reimbursement have found their tasks increasingly intricate. New guidelines brought in under the Affordable Care Act have only added to this burden. As Medicaid at the state level transitions to managed care on a larger scale, companies must react by tailoring their approach to meet those payers' specific needs.

This report provides insight into how companies are managing their operations in relation to US government reimbursement. In-depth discussions with pharmaceutical company executives and their advisors shed light on best practices throughout the product lifecycle.

CHAPTER OUTLINES

CHAPTER - 1

This chapter discusses how companies work with payers to position their products appropriately on formularies. Discussions with payers at an early stage of product development are crucial. Other key components of a government payer strategy are making sure that meetings are of a suitable length and contain information targeted to payer needs. To collect and present these data successfully, it is important that managed markets, medical affairs and clinical groups within the company coordinate responsibilities smoothly.

CHAPTER - 2

Amid the growing influence of the Affordable Care Act, government reimbursement continues to be a hot topic. Even before a company launches a new product, teams must determine what steps are necessary to secure support from federal and state reimbursement agencies. In some cases, this may require regional specialization. In others, teams may reach out to physicians and other healthcare consumers to gather product support prior to market availability. Chapter 2 focuses on the teams involved and the metrics used within companies' pricing processes. This chapter also addresses the reimbursement challenges associated with defining fair market value.

CHAPTER - 3

This chapter shows how teams structure government reimbursement operations and spend budgets. Government reimbursement team structures often vary by company size, but how teams operate depends on the number of products that generate a significant amount of revenue through government reimbursement. Regardless of team structure, most surveyed companies allocate their spending so that the majority goes to account manager compensation. Finally, outsourcing is a common practice among government reimbursement teams - especially for third-party compliance audits.

SAMPLE

Figure E.1:
Primary Function Communicating with US Government Payers

Table of Contents

Executive Summary

  • Study Definitions
  • Managing US Government Payers: Three Recommendations for Success

Gaining Optimal Formulary Position with US Government Payers

  • Establish Constant Contact with Government Payers Often to Keep Decision Makers Informed
  • Anticipate Government Payers' Expectations

Implementing Clear Pricing Processes to Better Navigate US Government Reimbursement

  • Involve Multiple Functions to Promote Consistent Government Reimbursement Strategy
  • Establish Reimbursement Procedures Using Specific Metrics

Expanding Government Reimbursement Capabilities through Structure, Budget Allocation and Outsourcing

  • Structuring Reimbursement Teams to Improve Internal Coordination and Communication
  • Benchmarks and Guidelines for Allocating Government Reimbursement Budgets
  • Employing Vendors to Build Reimbursement Models and Ensure Compliance

Executive Summary

Managing US Government Payers: Three Recommendations for Success

  • Figure E.1: Primary Function Communicating with US Government Payers

Gaining Optimal Formulary Position with US Government Payers

  • Figure 1.1: Overview: Meeting with US Government Payers
  • Figure 1.2: Phase During Which Companies Begin Meeting with US Government Payers

Establish Constant Contact with Government Payers Often to Keep Decision Makers Informed

  • Figure 1.3: Duration of Meetings with US Government Payers, by Phase
  • Figure 1.4: Duration and Number of Meetings with US Government Payers: Phase 3
  • Figure 1.5: Duration and Number of Meetings with US Government Payers: Registration and Launch
  • Figure 1.6: Primary Function Communicating with US Government Payers
  • Figure 1.7: Functions Involved in Getting a Product on the Formulary: Top 50 Companies
  • Figure 1.8: Functions Involved in Getting a Product on the Formulary: Small Companies

Implementing Clear Pricing Processes to Better Navigate US Government Reimbursement

  • Figure 2.1: US Government Reimbursement Process at a Glance

Involve Multiple Functions to Promote Consistent Government Reimbursement Strategy

  • Figure 2.2: Functions Involved in the US Government Reimbursement Process: Top 50 Companies
  • Figure 2.3: Functions Involved in the US Government Reimbursement Process: Small Companies
  • Figure 2.4: US Government Reimbursement Team Structure: Sample Structure A

Establish Reimbursement Procedures Using Specific Metrics

  • Figure 2.5: Functions Involved in Calculating BP and AMP Data
  • Figure 2.6: Functions Involved in Submitting BP and AMP Data to CMS
  • Figure 2.7: Functions Involved in Calculating Quarterly Rebate
  • Figure 2.8: Price Tracking Strategy, by Company
  • Figure 2.9: Companies' Perception of US Government Payers' Strategic Importance to Reimbursement, by Payer Type

Expanding Government Reimbursement Capabilities through Structure, Budget Allocation and Outsourcing

  • Figure 3.1: Overview: US Government Reimbursement Structure, Budget Allocation and Outsourcing

Structuring Reimbursement Teams to Improve Internal Coordination and Communication

  • Figure 3.2: Ways in Which Companies Organize Their US Government Reimbursement Teams
  • Figure 3.3: Ways in Which Companies Organize Their US Government Reimbursement Teams: Top 50 and Small Companies
  • Figure 3.4: US Government Reimbursement Team Structure Depends on Company Size
  • Figure 3.5: Percentage of Centralized US Government Reimbursement Teams Reporting to a Larger Group
  • Figure 3.6: Team Operation Depends on Exposure to US Government Reimbursement
  • Figure 3.7: Percentage of Companies with a Dedicated Contracts and Pricing Committee
  • Figure 3.8: Annual Spending for US Government Reimbursement (2012-2014), by Company

Benchmarks and Guidelines for Allocating Government Reimbursement Budgets

  • Figure 3.9: Average Percentage Breakdown of US Government Reimbursement Budget Allocations: All Companies
  • Figure 3.10: US Government Reimbursement Budget Allocation: Top 50 Companies
  • Figure 3.11: US Government Reimbursement Budget Allocation: Small Companies

Employing Vendors to Build Reimbursement Models and Ensure Compliance

  • Figure 3.12: Percentage of US Government Reimbursement Budget and Activities Outsourced
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